DISCLAIMER: The cases / examples on this blog have been anonymised to maintain confidentiality of patients. Cases have been acquired from various international hospitals and through other medical colleagues with the intention to teach through case examples.

Monday, 4 June 2007

The following includes two cases of Measles in as many weeks, both in adults.The first case was a female patient who had not be vaccinated.

She had a mild rash, fever, conjunctivitis and Koplik spots. She did not appear to have any remarkable systemic compromise. She was allowed to go home but restricted to her home until she became well-- a self-imposed quarantine.

The next case was a young adult male with a one week history of fever, sore throat, malaise, rash and vomiting. He too had been unvaccinated.

He was severely unwell with a high fever and sweating. He had multiple Koplik spots, a peripheral blanching maculopapular rash, although on his face, the rash had become confluent.Examination of his chest revealed reduced air entry at his left base and abdominal examination showed mild hepatosplenomegally. This was indeed a severe case and a primary measles pneumonia was suspected. Liver function tests were mildly abnormal consistent with the physical findings.

There has now been an explosion of cases of measles of epidemic proportions and these cases have also occurred in the unvaccinated adults.

With myself being trained in immunology, I recognise how important it is to adequately immunise the children and adults alike in an at risk population. The take up of MMR is Japan has been inadequate and even some doctors that I know have never been vaccinated and are therefore at risk.

Immunising the bulk of the population generally ensures that such an infectious and potentially fatal illness cannot take hold in the population at large. Those individuals not immunised are protected by the 'herd immunity' of the population already immunised.However, if the take up rate of vaccine decreases, then a hiatus occurs which allows the infection the ability to return with catastrophic consequences.

The other problem that exists is that the number of available vaccines has almost been depleted and hence, even if people want to be vaccinated, they cannot easily find the vaccine. It would seem that Japan was taken unawares of the potential outbreak.

The current epidemic shows how important vaccination is to prevent disease. Side effects from vaccination, albeit rare, do not outweigh the benefit of life saving immunity.The previous concerns about Crohn's disease and autism from combined MMR vaccination have never been proved and when this similar problem occurred in the UK, the Government at that time, did everything possible to ensure that vaccination was maintained to a high level. However, vaccination levels also dropped, as in Japan, and new cases of Measles began to occur.

However, the outbreak in Japan may be more extensive than that seen in the UK and there may be more cases of measles yet to occur. Case fatalities will occur as it is inevitable with this infection.

I only hope that the correct preventions are used by health care providers to ensure that spread is restricted as much as possible and that correct quarantine procedures are adhered to.I hope that in the future Japan will see a higher level of vaccine uptake to ensure that an outbreak of measles never happens again and this disease become a medical relic in the textbooks like Smallpox !